Medical Home Monitor
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November 16, 2009
Vol. II, No. 14

Medical Home Monitor Archives

Medical Home Q&A's:

CMS's Shelved Pilot;
Bundled Payments Distribution

Medical Home Monitor

Impact of CMS's Cancelled
Medicare Medical Home Pilot

Q: What does CMS’ shelving of its Medicare medical home demo say about its commitment to the patient-centered medical home model of care?

A: The accountable health organization is going to replace a lot of medical home discussion. There must be five or 10 different varieties of medical homes that we see out there right now. CMS is looking for a more stringent definition of an accountable health organization. One of the pieces CMS did not put in the original Medicare demo project was a discussion about bundling of services both for the provider and for the hospital and other services. That’s something CMS needs to do to make this concept work. (William DeMarco, president and CEO of DeMarco and Associates)

For more healthcare trends and forecasts for 2010, please visit:

Best Practices for Distributing
Bundled Payments

Q: Based on your experience in the CMS bundled payment demo, what is the best way to set up distribution of bundled payments?

A: The best way that we found to distribute the bundled payment is through the physician-hospital organization ( PHO). Decisions about gainsharing are made at the PHO board level. The physicians didn’t want everything coming through the hospital and the hospital being the bank. We didn’t want that either. We needed to develop a sense of shared governance; ultimately, the decision was to run the distribution through the PHO. We have a third-party administrator who handles the claims processing directly with the fiscal intermediary. In other words, once that clean claim is received by TrailBlazer, the payments are transmitted electronically; we then adjudicate the claims within three days and turn around that payment to the physician. The physicians receive their payment from the PHO through our claims administrator.

There were some glitches electronically between the fiscal intermediary and our third-party administrator. There were some delays in getting claims processed. In many cases, physicians had claims kicked back, so it was a delay on their part. But after the first few weeks, we workedeverything out and now it is flowing just fine. The physicians are being paid within three days of what they historically have been paid and we haven’t had any issues arise recently regarding payment. (Michael Zucker, chief development officer of Baptist Health System)

For more information on bundled payments, accountable care organizations and medical home reimbursement, please visit:

House Reform Bill Supports Medical Home Pilots & Payments

The healthcare reform bill narrowly passed 10 days ago by the House of Representatives would allocate $30 million over five years for pilots of both independent and community-based patient-centered medical home (PCMH) models.

The House bill encourages PCMH pilots "in a variety of settings, including urban, rural, and underserved areas" and rapid deployment of the PCMH on a national basis, particularly for high-risk Medicare beneficiaries. The bill proposes that prospective payments to medical homes be "based on beneficiary risk scores to ensure that higher payments are made for higher-risk beneficiaries." Supported is a prospective monthly fee for each targeted high-need beneficiary in an independent PCMH and two monthly prospective payments in a community-based PCMH (for the community organization and PCP).

The bill encourages participation by physician practices large and small, defines larger PCMH roles for nurse practitioners and physician assistants and advocates the use of evidence-based guidelines in the PCMH. Also supported is a $1.2 billion five-year medical home pilot for Medicaid beneficiaries that encourages the use of technologies like wireless patient monitoring to "enable providers and practitioners to communicate directly with their patients in managing chronic illness."

The PCMH is one of several "innovative payment mechanisms" supported by the House bill, along with "accountable care organizations, value-based purchasing, bundling of services, differential payment rates, performance or utilization based payments, partial capitation and direct contracting with providers."

The passage of the bill is the first of several legislative hurdles on the road to comprehensive healthcare reform. To read the 1,990-page House bill in its entirety, please visit:

HealthSounds Podcast: Geisinger Case Manager Benchmarks and Strategies

Case managers are the backbone of the Geisinger Health Plan (GHP) Health NavigatorSM program, a medical home partnership between PCPs and GHP that has reduced 30-day hospital readmissions by 15 to 20 percent. Providing benchmarks for case manager caseloads and contact frequency, tools to support case management, the key to smooth placement of case managers in the medical home and tips for better management of patients discharged to nursing facilities are Diane Littlewood, R.N., and Joann Sciandra, R.N., both regional managers of case management for health services at GHP.

To listen to this HIN podcast, please visit:

WellCentive Provides Free Registry Licenses for Michigan Providers

More than 1,000 Michigan providers took advantage of a limited-time offer for free one-year registry licenses, interfaces, implementation support and project management from WellCentive.The WellCentive Registryis a comprehensive, point-of-care, Web-based preventive care and chronic disease management solution, normally costs $550 per provider per year.

The offer had been extended to all providers in Michigan that were not already WellCentive customers. The free registry license program includes an inbound lab results interface with Quest Diagnostics and outbound interfaces to Priority Health and Blue Care Network for pay-for-performance (PFP) reporting. WellCentive’s point-of-care patient registry systems and HIE platforms systems support the PCMH, PFP, CMS PQRI, chronic disease management and other programs.

"While many Michigan providers have been using WellCentive Registry for years, not everyone understands how registries can engage physicians, improve care and cut costs using point-of-care decision support, population-based reporting, and automated patient outreach," said Paul D. Taylor, M.D., WellCentive’s CEO and medical director. “We wanted to encourage physicians and physician organizations that are on the fence, to take the plunge and join the growing clinical quality improvement movement,” said Taylor.

For more information, please visit:

HIN Survey of the Month: Reducing Hospital Readmissions

Healthcare reform and the posting of hospital readmission rates for Medicare patients with heart attack, heart failure and pneumonia on the CMS Hospital Compare site and the tying of these rates to reimbursement are making healthcare organizations work harder to keep patients from returning to the hospital. Describe your strategies by taking the HIN 2009 Hospital Readmissions Benchmark Survey and receive an e-summary of the results once the survey is completed.

Complete the survey by visiting

Healthcare Trends Update: Care Transitions Across Sites

Planning for patients' care transitions can have a significant effect on health outcomes, likelihood of readmission and ER visits, utilization cost and the burden on caregivers and family members. This white paper is based on responses from nearly 100 healthcare organizations to HIN’s April 2009 e-survey. Respondents shared their organizations' experiences with care transitions.

To download this complimentary white paper, please visit:

Medical Home Reimbursement ABCs: Funding Care Delivery through ACOs, Bundled Payments and Concrete Contracts — Save 10% on Purchase

This 50-page report provides a primer on new reimbursement models — accountable care organizations and bundled payments — supported in healthcare reform legislation and getting payors' and providers' attention for delivering cost savings. This report profiles three healthcare organizations that are redefining healthcare reimbursement with their pilots of new payment models and contracting strategies.

Use ordering code MHMP to reserve your specially priced resource by visiting:

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